Asthma

Question 1

What is asthma?

Answer 1

Chronic inflammatory disease characterised by reversible airway obstruction.

Question 2

What are the signs and symptoms of asthma?

Answer 2

Coughing
Wheezing
Shortness of breath
Remember to ask if the patient has a history of atopy, e.g. hay fever and eczema.

Question 3

List some triggering factors of asthma.

Answer 3

Dust/pets/vapours.
Emotion.
Drugs, e.g. beta blockers.

Question 4

What investigations are performed for asthma?

Answer 4

Peak expiratory flow rate: note diurnal variation.
Sputum sample.
ABG: in emergency.
Spirometry: for obstructive defects.
Bloods: increased IgE, FBC.
CXR: pneumothorax, consolidation.

Question 5

How is acute asthma treated?

Answer 5

Oxygen
Salbutamol
Hydrocortisone
Ipratropium
Theophylline
'O SHIT'

Question 6

What are the complications of asthma?

Answer 6

Death
Disturbed sleep
Persistent cough
Side effects of steroids:
-weight gain
-thinning of skin
-striae formation
-cataracts
-Cushing's syndrome

Question 7

What is the pathophysiology of asthma?

Answer 7

Copious mucus secretion
Inflammation
Contraction of bronchial muscle
Allergen affects Th2 cells.
Interleukin (IL)-4 stimulates eosinophils and B lymphocytes.
B lymphocytes produce IgE, which causes mast cells to degranulate.
When mast cells degranulate they release histamine, and this histamine causes bronchoconstriction.
IL-5 stimulates eosinophils.
IL-13 stimulates mucus secretio.

Question 8

What is the conservative treatment of asthma?

Answer 8

Patient education, advice on inhaler technique and avoidance of triggering factors, annual asthma review and influenza vaccine required.

Question 9

What is the medical treatment of asthma according to the British Thoracic Society guidelines?

Answer 9

Step 1: salbutamol (short acting beta-2 receptor agonist).
Step 2: step 1 + beclometasone (inhaled steroid).
Step 3: step 1 + 2 + salmeterol (long-acting beta-2 receptor agonist) + increased total dose of inhaled steroid.
Step 4: steps 1-3 + increased dose of inhaled steroid + consider adding additional therapy, e.g. theophylline (xanthine derived bronchodilator that inhibits phosphodiesterase), montelukast (leukotriene receptor antagonist).
Step 5: oral prednisolone (steroid) + high dose inhaled steroid, refer to specialist.